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Mental Health Issues Among Doctors

Dr Patrice Baptiste highlights how mental health is not often discussed among medical professionals and how even today, mental health conditions have a high level of stigma attached to them which can prevent doctors from seeking help. 
Discussions about mental health are almost non-existent in the medical profession. Doctors work unsociable hours and have immensely stressful jobs, but we somehow believe that everyone is able to cope superbly, and no-one appears to be managing any mental or physical health problems. When sick, doctors work as usual. This could be due to the pressures of work, or the expectations placed on them by themselves and others, both in and out of the workplace. How can the sick be treating the sick?
It is so important that we discuss and highlight mental health issues amongst doctors, and try to erase the stigma associated with this topic. This will allow us as doctors to be the best we can be for ourselves, our loved ones and ultimately the people we care for, our patients.
Several facts about, and possible solutions for, mental (and physical) health issues are listed below:
1. Mental health conditions amongst doctors are not confined to one country but affect doctors all over the world1.
2. Common mental health disorders identified include depression, anxiety, addiction to drugs (this includes prescription drugs), burnout and suicidal thoughts1.
3. Doctors at any level of their career can be affected. Issues can arise during the foundation stage/residency, later on when they are a newly qualified consultant, or even when established in their profession for many years1,2.
4. Issues can arise due to: 
a. Occupational risk factors:
i. The high level of interaction with patients and staff can often be emotionally draining.
ii. Unsociable hours and long (12-14 hour) shifts which can affect the length and quality of sleep.
iii. Understaffing, lack of support at work and even bullying.
iv. Higher expectations from patients1, and from the government, with changing policies including ‘seven day working’3.
b. Personal risk factors1:
i. Doctors are more likely to be perfectionists, (and may also possess obsessive compulsive qualities). They can therefore be quite harsh on their own performance and abilities3.
ii. It is thought that personal factors can make certain people more vulnerable to suffering from mental health disorders1.
c. Debt from student loans (especially since the introduction of university fees  up to £9,000), and poor pay, especially for junior doctors, (which may become a bigger issue in light of the recent changes proposed by the secretary of state for health), mean that doctors will be worried about their future and financial security. This could well affect their mental (and physical) health.
d. Lack of a permanent location. During training, doctors usually rotate to various specialties every four to six months, and often to different hospitals every year. This lack of stability can cause families to be uprooted and experience long periods of separation. This can disrupt the support network for the doctor that is so crucial to a healthy mental state.

5. Factors that impede doctors seeking help:
a. The stigma associated with mental health issues and thus the impact on their career.
b. Embarrassment. Doctors may compare themselves to their counterparts and feel that they are not as ‘strong’1.
c. Denial. It may take something serious such as an obvious physical illness to alert someone to other issues they may have not otherwise considered.
d. Lack of knowledge about services aimed at helping those suffering with mental health conditions.
e. Guilt. Doctors may feel guilty due to gaps in the rotas or added pressure on other members of staff. Guilt can also be initiated by other members of staff; this could be  doctors on their team or rota co-ordinators and medical administration.
f. Doctors may decide to diagnose, treat and even prescribe for themselves instead of seeking help from their own general practioner1.

6. Interventions:
a. Support at various levels:
i. Supervisors who are easily contactable and approachable
ii. Adequate support during long shifts and ward work.
iii. Deanery meetings to highlight issues such as bullying, staffing levels and support for doctors in their current placements.
iv. Specialist support services: anonymous counselling, via telephone or face to face (whichever the individual prefers). There is currently the Practitioner Health Programme which provides a confidential service for doctors suffering from mental or physical health issues. However, it only operates in London4.
b. Adequate advertising for existing support services. This may include lectures to let medical students and doctors know where they can find help.
c. Further studies in this under-researched area. 

1. Brooks, S.K., Gerada, C., Chalder, T. Review of the literature on the mental health of doctors: Are specialist services needed? Journal of Mental Health. 2011; 1-11
2. Caplan, R.P. Stress, anxiety and depression in hospital consultants, general practitioners and senior health service managers. British Medical Journal. 1994(309); 1261-3
3. Edwards, N., Kornacki, M.J., Silversin, J. Unhappy doctors: what are the causes and what can be done? British Medical Journal. 2002(324); 835-8
4. The Practitioner Health Programme (PHP): Link Accessed: [12:08:2015].

Below are a small selection of the useful resources available to help medical professionals with mental health issues:
1. Guidance from the GMC for medical schools to support students with mental health issues: Link
2. The Practitioner Health Programme (NHS). This is a confidential service for doctors and dentists with mental and physical health conditions: Link
3. Mednet is a confidential service for doctors and dentists with mental health conditions, based only in London and for professionals in training programmes managed by the Local Education and Training boards (LETBs): Link
4. The Sick Doctors trust is another confidential service aimed at those who are suffering from addition to drugs and/or alcohol: Link
5. The BMA Counselling and Doctor Advisor Service offer a free telephone consultation service to doctors who are suffering with mental health issues: Link
6. Interesting case studies from doctors who have left the medical profession and the mental health issues they surmounted: Link
Dr. Patrice Baptiste is currently taking a gap year after the foundation programme. She volunteers as Director Appointee at a Primary School in East London and is also an alumni committee member on the Black and Ethnic Minority (BME) steering group at University College London (UCL). She also tutors students in her spare time.  


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